By Neil Trainis

Exclusive: North-East London local pharmaceutical committee chief executive Shilpa Shah has said the Additional Roles Reimbursement Scheme, introduced by the government four years ago to improve patients’ access to general practice in England, should be expanded to alleviate workforce pressures in community pharmacy.

In an exclusive interview with Independent Community Pharmacist, to be published in next month’s edition, Shah said pharmacies should benefit from the scheme just as surgeries do by allowing pharmacists recruited into ARRS roles to split their time between working in community pharmacy and general practice.

Pharmacy leaders have been concerned for some time that pharmacists choosing to work in general practice is exacerbating a workforce crisis in community pharmacy and the ARRS has done little to alleviate those concerns.

Shah said she understood why pharmacists decide to work in surgeries, describing it “less stressful” than working in community pharmacy, but insisted the ARRS could take the strain off pharmacies struggling with increasing overheads and tight budgets if its scope was widened beyond general practice.

“People who work in community pharmacy post-Covid are really stressed and quite burnt out and it always feels as though the grass is greener if you can go and work in a surgery, 9 to 5.30, Monday to Friday, in a role that is less stressful. You’re not seeing 15 patients per 10 minutes, you’re seeing 15 patients over three or four hours,” she said.

“I think that’s a massive factor why people are leaving community pharmacy and going into these ARRS-funded roles. We’re definitely seeing that. I know someone now who’s just left. I asked her ‘what are you going to do, anything nice?’ and she said ‘I’m working in a PCN.’ So, yes, it’s happening.

“My solution is, if these ARRS roles continue, it should be a real, clear ‘you do three days in surgery and two days in a community pharmacy neighbouring that surgery.’ Wouldn’t the vision in the future be amazing if it was ‘you’ll do a day in the surgery, a day in an opticians, a day in a dental surgery and a day in a community pharmacy.’

“In an opticians, you’ve got people who need medication for the eyes and you can see how that works. For dentists, you could do a lot around pain in antibiotics. You could do a day on the integrated care board. The ARR role shouldn’t be a based-in-a-surgery role.”

Insisting the ARRS “needs to be a true primary care role because that would really help the workforce,” Shah said the scheme would improve general practice’s understanding of how its actions impact community pharmacy, such as inappropriate referrals though the GP community pharmacist consultation service.

“It would basically help GP surgeries have their person but that person, if they did three days in a surgery and two days in community, would see the impact of some of the drug changes they make, they would see how that affects community pharmacy,” she said.

“They would see what happens when you send out a GP CPCS referral that’s inappropriate, so they could use those skills to take back to the surgery to say ‘I was working in a community pharmacy the other day, someone sent through GP CPCS referrals that were definitely something more serious’ and they would able to retrain that person.

“That’s what I’d like to see, a vision for those roles. That would help with the workforce because it would mean an independent contractor, for example, could have two days off in the week, one day to go and do all their paperwork that’s causing them all the stress, one day to have a rest because they know they’ve got the same pharmacist two days a week for two years as part of this PCN role.”

Talk to CPhO Webb about ARRS pilot   

Shah also said she would talk to the chief pharmaceutical officer David Webb about running a pilot in North-East London in which individuals from different health professions recruited into ARRS roles spend half their time working in a community pharmacy. 

The ARRS provides funding for 17 roles at the moment, including pharmacists, pharmacy technicians, nursing associates, paramedics, dietitians, mental health practitioners and first contact physiotherapists.

“I’d like to see community pharmacy being funded for ARRS roles but failing this, I think all appointments from April 2023 for an ARRS role should involve that person spending 50 per cent of their time in community pharmacy which is part of primary care,” she said.

“This would help with relationships between surgeries and GPs, support portfolio working and also finding solutions for challenges as these individuals would see things from both sides.

“Wouldn’t it be great if we could make sure any contract into a PCN ARRS role – and it could even be nurses because they could come out and do vaccinations, it could be paramedics, it doesn’t just have to be pharmacists – they could spend some of their time in the surgery and some (in community pharmacy).”

Suggesting she would run the idea of a pilot past Webb, Shah said: “We’re so busy fire-fighting and there’s so much going on that everyone is fighting for the same workforce and it’s not that they don’t want to share but they can’t see how it’s going to benefit them.

“NHS England don’t always see that but I think there would be a huge benefit even if we piloted it in North-East London. I’d be happy to pilot that and see how it goes. Let’s pilot it for six months to a year and really see the benefits of that.”

NHS England told ICP that ARRS roles work across primary care locations, not only GP surgeries because primary care networks cover populations of 30,000 to 50,000. However, NHS England did not say if it was open to Shah's idea of a pilot.